- The Cigna Group (Bloomfield, CT)
- …In addition to identifying root causes of quality and accuracy issues, they will provide technical support and coaching for our data stewards. The data ... project. They will help to drive improvements in the provider data domain to ensure we meet...assisting with improved claims auto-adjudication. + Work within the Data Quality management process to champion incremental… more
- The Cigna Group (Bloomfield, CT)
- …representing over 40% of Cigna's total medical cost savings. The **NANPM Medicare Senior Advisor** is responsible for negotiating Medicare Supplemental ... NANPM Management Process, supports implementation of strategic priorities, and provides data and information to maximize value. This role collaborates with Vendor… more
- The Cigna Group (Bloomfield, CT)
- …within the Medicare Stars Analytics team, who's function is to provide operational and analytical support to internal and external partners to improve Cigna's ... data including healthcare claims, clinical outcomes and Stars quality measures to make recommendations based on relevant findings....to detail and accuracy + Work experience as a Data Analyst in Medicare Stars, specifically in… more
- The Cigna Group (Bloomfield, CT)
- …+ Performs data validation analysis, including high level data quality /audit checks, process/logic/assumption documentation and ongoing monitoring and ... position within the Medicare Growth Analytics Team is an opportunity to provide leadership on our analytics strategy, to support our broader Medicare Growth… more
- The Cigna Group (Bloomfield, CT)
- …of all supporting documents to determine how to correctly enter the appeal data in the appropriate data system. Proactively communicates with appellants, ... cases + Independently conduct thorough review of all new member and provider correspondence by analyzing all the issues presented to determine appropriate… more
- The Cigna Group (Bloomfield, CT)
- …an individual contributor responsible for supporting the analytics strategy for Medicare Health Services, performing research and analysis within the Clinical ... team. This role will help us accomplish this through data -driven analytics, strategic insights, and collaboration with our internal...to meet our goal of reducing costs and increasing quality of care to our members. This individual will… more
- Humana (Hartford, CT)
- …they need, when they need it. These efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service ... address gaps to targeted metrics. Leverages market level projections and experience data tools to research root cause and capture insights. Researches and… more
- Baystate Health (Springfield, MA)
- Baystate Health, a nationally recognized leader in healthcare quality and safety, and home to Baystate Medical Practices, the largest multispecialty group in the ... region is looking for an experience **RN, Provider ** **Clinical Compliance Auditor** to join the Baystate Medical Practice Revenue Integrity Team **Full Time -Remote… more
- The Cigna Group (Bloomfield, CT)
- … data related investigations, track lineage and quality issues, reviews data layout and structures + Provide support in Production issue/defect resolution ... Facilitate source business owner review sessions and plan/execute E2E, integration, and data quality validations + Collaborate with the business, compliance, and… more
- Humana (Hartford, CT)
- … assets, enterprise-wide governance processes and tools, sensitive data management, data literacy and data quality . This individual will collaborate ... data governance, data lineage and mapping, data enrichment, data quality , ...need it. These efforts are leading to a better quality of life for people with Medicare ,… more
- Humana (Hartford, CT)
- …they need, when they need it. These efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service ... services using technology and analytics. We are looking for a Senior Data Scientist who will utilize cutting-edge AI, NLP, GenAI techniques, build predictive… more
- Humana (Hartford, CT)
- …the care and service they need, when they need it. The result is a better quality of life-not only for people with Medicare and Medicaid but also for families, ... health outcomes, reduce medical costs, enhance operational efficiency, reduce provider /member abrasion, and improve compliance across Medicare ...need it. These efforts are leading to a better quality of life for people with Medicare ,… more
- Elevance Health (Wallingford, CT)
- …member of Elevance Health's family of brands. We administer government contracts for Medicare and partner with the Centers for Medicare and Medicaid Services ... federal health programs._ The **Audit and Reimbursement Senior** will support our Medicare Administrative Contract (MAC) with the federal government (The Centers for… more
- Elevance Health (Wallingford, CT)
- …health administration, nursing, or a related clinical field; 4 years of health care quality or data analysis experience; or any combination of education and ... understanding of regulatory standards and guidelines pertinent to healthcare data and quality reporting + Experience working...quality reporting + Experience working with Medicaid and Medicare plans a plus. Please be advised that Elevance… more
- Humana (Hartford, CT)
- …they need, when they need it. These efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service ... Medical Director relies on broad clinical expertise to review Medicare drug appeals (Part D & B). The Medical...to complex issues where the analysis of situations or data requires a case by case consideration of the… more
- Elevance Health (Wallingford, CT)
- **JR130960 Business Change Director ( Quality Control Test Architect, PBM systems)** CarelonRx's Business Operations org is looking to hire a PBM Test Program Manager ... / Quality Control Test Architect. This high-performing individual contributor will...status as defined in the test plan with supporting data . + Manages both onshore and offshore test execution… more
- Humana (Hartford, CT)
- …national level. + Develops policy and procedure, and defines/improves processes regarding quality measurement data collection and improvement methodology for all ... Excel. + Demonstrated ability to perform moderate to complex data analysis. + Strong relationship building skills. + Excellent...need it. These efforts are leading to a better quality of life for people with Medicare ,… more
- CVS Health (Hartford, CT)
- …+ Analyze various sources of patient care and claims data , including 100% Medicare data or VRDC, to provide actionable insights to stakeholders + ... **What will you do?** + Evaluate the impact of Medicare quality and risk adjustment program has...Mathematics, Statistics, Actuarial Science or closely related field. Experience w/ Medicare Limited Data Set (5% Sample … more
- The Cigna Group (Bloomfield, CT)
- …our success. **Role Details** As an enabler of Enterprise Strategic Priority for Medicare Advantage Growth, the Dedicated Medicare Operating Model (DMOM) program ... be leveraged within the program and post-program operations to ensure a high quality of system performance. This individual will work with business, technology, and… more
- Humana (Hartford, CT)
- …+ 3+ years of data analysis skills + 1+ years of healthcare provider data experience + Advanced experience in developing SQL queries + Advanced Microsoft ... Azure Synapse Analytics + Proficient in understanding Healthcare related data + Medicare and/or Value Based knowledge...need it. These efforts are leading to a better quality of life for people with Medicare ,… more